The Trump Administration’s fulfillment of a promise to back out of the Paris Climate Accord is under way. It is tragic, isolationist, perverse in its reasoning, and will ultimately lead to much suffering. There is nothing justifiable, rational, or scientifically sound about this decision, and I will not rehash the obvious. Time will tell if the efforts of progressive U.S states, cities, and corporations can mitigate this catastrophic action. The actions of the rest of the world matter even more. It might be too late, even with the Paris Accord, to stop the inevitable climate change disaster. And so while we are hoping for new leadership, new technologies, and perhaps some future geoengineering messiah, a few small daily commitments from billions of people might help. So here is my Paris Micro-Accord:

1) I hereby commit to purchasing/leasing a Tesla electric vehicle in the next few years. With the prices of new models coming down, mass production of batteries with state-of-the-art tech, and a visionary leader, Tesla deserves to be rewarded. This set will require ratification from wife, and some major financial planning. Should be less expensive than a dumb Chevy Tahoe and the like.

2) Schedule a meeting at my office for one lousy hour to brainstorm ways to run the office more efficiently, cut down on energy consumption, waste, better promote recycling, and encourage more green-minded food consumption. This might include a review of the travesty that is the trash can after one single lunch break, full of plastic containers, fast food packaging, water bottles, etc. Lights are constantly left on. During the course of a single day, the heat has been put on in the morning, windows opened midday, and the air conditioning turned on by the afternoon, often with the windows still open. Are you kidding me?

3) I vow to plant more trees in open sidewalk cut-outs in my city. These ugly dirt pits are crying out for a tree to suck up carbon, cool the street with shade, and scare away criminals – seriously.

4) As a physician, I recommit to lifestyle counseling instead of heavy reliance on pharmaceuticals. For example, a recent study proved that going for a 15 minute walk after each meal for a person with diabetes can be more effective than a single medication for treatment of diabetes. Eating for the environment (organic, plant-based, minimizing meat and processed foods, etc) is good for the body, mind, and planet. It takes 441 gallons of water to produce a pound of beef, and 28 calories of fossil fuel energy to produce 1 calorie of energy from meat. The production of methane from the cattle industry is absurdly high, and the rest of the meat story on our planet is terrible.

5) I will try to synthesize a 1 page non-partisan tip sheet to give/email to patients, highlighting the overlapping benefits of certain behaviors, lifestyle choices, and dietary measures for body health and planetary sustainability.

5) I also vow to approach climate change skeptics and deniers with more compassion, understanding, and good-hearted manipulation tactics. Not simply quoting scientists, talking down to people, or forcing them to go along with the rest of their conservative tribe might help. Reading through this transcript of a conversation held on Science Friday with Ira Flatow interviewing three panelists/experts was very helpful in terms of techniques.

In the end, it’s going to be a mess. But we must fight the good, rational fight. Maybe it will work out, and in the process of fighting the good fight, may we find a rational coping mechanism for the anguish felt in this epic tragedy that is unfolding.

Tylenol, or generic acetaminophen, is often recommended as a safe medication for infants and children. As a physician and parent, I would like to ease the discomfort my child experiences with sore throats, fevers, and the like… but as I began scrutinizing the ingredients of infant and children’s liquid Tylenol and acetaminophen preparations, I became increasingly horrified by the additional ingredients. Butylparabens?! Is McNeil really putting endocrine disruptors in children’s medicine? Why are all the generics following suit? After searching through many pharmacies, and reading the labels on the liquid acetaminophen options, I finally found an alternative to brand name Tylenol that is dye-free and paraben-free, and therefore in my opinion safer:

While still not perfect, I was nonetheless elated to find a source of acetaminophen that did not contain parabens or dyes. Little Remedies contains acetaminophen, plus these inactive ingredients: citric acid, glycerin, natural flavors (?), potassium sorbate, povidone, propylene glycol, purified water, sodium citrate, sucralose, sucrose, xanthan gum. None of these ingredients raises any red flags as investigated for safety by Environmental Working Group (EWG).

As a reality check, these ingredients in small doses are probably not a big deal… but I don’t see any need for their inclusion when there are potentially safer alternatives. I generally distrust most of the inactive ingredients included in most big pharma-produced medications, and children’s liquid tylenol is just the most blatant example I’ve encountered in my quest not to “poison” my kid.

I’m glad there is at least one easily-found, liquid acetaminophen preparation for children that does not contain freaking parabens.

Of course there can be no definite, inarguable answer to the question of which sunscreen is safest for children, but Environmental Working Group has put a lot of time and effort into answering this question. They have given their safest “0” rating to only three sunscreens, but have given a very safe rating of “1” to 108 sunscreens. Narrowing this down can be overwhelming, so I’m going to describe my three favorites, and then talk more about why choosing a safe sunscreen for your children and yourself is worth the extra money.

Badger

We have used Badger sunscreen and found it to be quite effective. It gets a good rating in terms of being safe for children as a sunscreen. It is formulated with zinc oxide, which is unlikely to contain nano particles, and does a superior job of scattering UVA rays. The only downside for me is that even when thoroughly massaged in, the cream leaves a visible shiny matte on the skin. But who really cares about this aspect, and read below to see why I’ve come to this conclusion. Think of it as building character for your kids.

California Baby Sunscreen

California Baby is the sunscreen my family has used for the past several years. It strikes a decent balance between cost, ease of use, and safety, and is generally easy to find in stores. The ingredients overall are given a great rating by EWG, but it gets dinged for containing Cymbopogon schoenanthus oil (also called lemon grass oil). This compound is obtained by steam distillation of grasses, and therefore gets a bad rating in terms of allergies. The sunscreen agent is titanium dioxide, which usually contains nanoparticles (which may pose additional health risks discussed later in this post). It does slather on effectively, and generally works well to prevent burns. Perhaps the best compromise between performance, cost and safety.

Butterbean

Butterbean sunscreen gets a top nod for safety, and is the one I am planning on trying next. The major problem is that a 7-ounce tub will run you $18, and 3 ounces $10. Ouch. But the ingredients are practically food grade in terms of coconut and apricot oil. To lend substance beeswax is added, and sourced from a local apiary according to the producer, who just happens to be a concerned mom outside of Atlanta, Georgia. It can only be ordered through her website, but if you don’t mind paying artisan-level prices, this seems great. The sunscreen agent used is also zinc oxide and assured to be free of nanoparticles.

So there you have the three sunscreens I am most familiar with in terms of being safe for children, and therefore by extension myself.

Avoiding the sun still the best means of protection

Perhaps the most dangerous aspect of sunscreens is not their ingredients, but the false sense of security they lend. Perhaps you could truly find the safest sunscreen for children in the world, but if they are out playing soccer every day of their lives at noon, then this is really moot.

Total time in the sun may increase substantially for those who are misled into thinking that an SPF 50 sunscreen will block all UV radiation, and certainly prevent cancer. There is some evidence that regular application of sunscreen helps reduce the risks of squamous cell cancers. The evidence for basal cell cancer and melanoma is less robust. Some studies have actually found higher rates of melanoma in sunscreen users. The bottom line is that the question of whether sunscreens reduce skin cancers still lacks a consensus agreement on the answer. EWG says it better than I.

SPF ratings are based upon the sunscreen’s ability to scatter and block UV rays causing sunburns, typically UVB. UVA rays on the other hand, penetrate deeper and may be most associated with skin damage, immunosuppression, and melanoma.

Bottom line: Stay out of the sun during peak daylight hours. Wear protective clothing and a hat with a dorky wide brim. Avoid serious burns. But also understand that melanoma is a complex disease, and defies logic in several ways. People who work outdoors report fewer melanomas. Rates are higher in Northern cities compared to sunnier, southern ones. Most melanomas occur on areas of the body receiving less intense sun. In general researchers state to avoid sunburns, but perhaps not all sun exposure.

What are some hazards of sunscreen?

Certain ingredients may pose health risks. These include Vitamin A which has been shown to actually augment the formation of skin tumors. This ingredient is often listed as retinyl palmitate or retinol.

Oxybenzone can be found in half of the sunscreens out there. It soaks through the skin and has been found in the urine of children tested. It may disrupt the endocrine system, but some studies conclude it does not based on testing LH and FSH levels… but such high level regulatory hormonal feedback may miss low-level cellular signaling in my opinion.

What’s all this buzz about nanoparticles in sunscreen?

Nanoparticle sized titanium and zinc oxide are found in many sunscreens. By making the particles extremely small, products avoid the white chalky appearance one might recall from the past. It is difficult for producers to claim their products are totally nanoparticle free, and it is generally accepted that for titanium oxide to work it is by definition nano-size.

Here’s a counterintuitive truism: The smaller the particle size, the more clear the application, the better the SPF protection, and the worse the UVA protection. It is fairly safe to say that nanoparticles cannot penetrate the skin. The problem with these particles is mostly in terms of being inhaled, and the lungs have difficulty clearing such small particles in general, and this may contribute to carcinogenesis in the lung and other organs. Sunscreen ingredients have also been found to damage coral reefs, accumulate in fish, and disrupt amphibian and fish hormones.

In terms of nanoparticles, the medical reference UpToDate has this to conclude:

In vitro studies have indicated that nanoparticles of titanium dioxide may induce the generation of reactive oxygen species with and without UV irradiation, which is the proposed mechanism for its possible toxicity . Some in vivo and in vitro studies, however, have provided evidence that nanoparticulate titanium dioxide and zinc oxide do not penetrate beyond the stratum corneum.

In 2009, a review of studies on the use of nanoparticulate zinc oxide and titanium dioxide in sunscreens was performed by the Australian Government Therapeutic Goods Administration .The review concluded that titanium dioxide and zinc oxide nanoparticles do not reach viable skin cells, but they remain in the outer layer of the skin (stratum corneum) that is composed of non-viable cells.

Consider a vitamin D supplement

Most people who practice the current consensus to avoid excess sun exposure may end up becoming vitamin D deficient. Consider getting screened for deficiency, taking a supplement, and discussing this with your doctor.

So, what is the safest sunscreen for kids?

Hopefully this post has not been a complete rambling sham of confusion. As with any question, such as “What is the safest sunscreen for children?” looking for the right answer only leads to more questions and a deeper sense that we really don’t understand everything. And so that is where the intuition of experts can be a valuable mediator between conflicting variables. I’m not an expert, but from what I can glean from them, I would summarizes thusly:

Avoid sunburns, but not all sun exposure, wear protective hats and clothing during peak hours, and choose a sunscreen that contains zinc oxide and scores favorably in terms of ingredients, if only for your own sanity.

If finding products that are organic and eco-friendly is important to you, then shopping for a baby shifts this impulse into high gear. One of your most important searches will be for a high quality, organic crib mattress and a safe, healthy crib constructed from good materials. After considerable searching my wife and I chose these:

If you found this page through a random search for the best organic crib mattress or crib, then please know that I personally put in at least 10 hours researching these products! Although they are expensive, when you consider the amount of time babies and toddlers spend in their cribs, it is important to choose materials that are not cheap, hazardous, and off-gassing chemicals directly into the nursery air.

Why the Oeuf Sparrow Crib?
I liked this crib because of the solid wood construction. Pressed wood is made with glues and often puts out formaldehyde. There is a solid birch option which is not painted, but we went with the white color. The paint used by Oeuf is water-based and free of harmful VOC’s. The cribs are made in Europe under the strictest environmental standards, not in China. Aesthetically the Oeuf Sparrow crib is very attractive and in my opinion appears mid-century modern. One downside for me was that the base of the crib was some sort of plywood, not solid wood. I suppose this makes sense because solid wood can crack and warp, and the base needs to be sturdy. Oeuf provides reassurance thusly: “Engineered hardboard panels are made from recovered wood fibers, meeting European E1 emissions standards as well as California’s CARB 1 and 2 emissions standards.” In my paranoia I actually painted the base anyway, using a zero VOC Mythic Non-Toxic Paint, let it dry outside for a day, and plywood smell problem solved. The eco-friendly crib is made from sustainably sourced wood in a Forest Stewardship Council certified facility.

Why the Coco Mat Organic Crib Mattress?

We chose NaturalMat’s mattress over Ouef’s crib mattress. Either would have been excellent choices, but NaturalMat’s organic crib mattress won us over for these reasons: there is no latex, it is made from organic coir (coconut husks) and organic wool (thermally insulating), yet it is very breathable. Lavender, eucalyptus, and lemon extracts help make it dust-mite resistant in a natural way, and from experience lend no detectable smell. The Cocomat is naturally fire retardant without any harmful PBDE retardants. It is made in England and seems completely non toxic with no polyethylene or synthetics.

Why the Organic Cotton Flannel Mattress Pad?

It looked cozy, and the material is made of two layers of 100% Egyptian Certified Organic Cotton Flannel with ultra-thin waterproof membrane in center. No vinyl/PVC, phthalates or latex are used. You could go without the mattress pad but chances are your baby will have some accidents, snotty nights, etc…

Are Organic and Green Materials Worth It?

Is this level of concern about materials excessive? Perhaps. With all the other crap in our daily environments, choosing the best organic crib mattress and eco friendly crib might seem absurdly reductionist. Your baby will be exposed to countless chemicals regardless, right? But once again, the amount of time spent in the crib, and the intimate proximity of the materials to the baby’s skin and respiratory system compelled us to fork over some big bucks on a green, high-quality crib and mattress. If it is only for peace of mind, and less than scientifically proven to keep your child healthier, then so be it. That mid-century modern crib aesthetic in the age of Mad Men is valuable, too.

When it comes to choosing which plastics are the best or most safe, remember this:

Zero is best. 2, 4, 5 if you must.

And of course you must.

Besides homesteading in Maine, off the grid, recreating life from the 1880’s, it is nearly impossible to avoid plastics. But we should try to minimize their use, for our own health and for the greater health of the planet.

The damage already done by plastics will be apparent for millennia, as plastics do not readily degrade. They are microscopically choking our waterways and oceans, and macroscopically filling our landfills and environment. A full accounting is outside the scope of this post, but besides choosing alternatives to plastic in our everyday lives, how can we differentiate among the various types of plastic in terms of potential harm? One way is to consider the recycling number assigned to many plastic containers.

What do the plastic numbers mean?

A classification system was developed in 1988 to differentiate between the various types of plastic in order to facilitate recycling. Plastic manufacturers are not required by law to imprint the classification number on their products, but many do. A convenient outcome of this system is that we can be selective in terms of what we bring into our homes, how we prepare and eat food, etc.

#1 PET or PETE – polyethylene terephthalate. Used in many juice, soda, water, nut butter, salad dressing, and detergent containers. May leach antimony trioxide, which in higher doses causes respiratory and skin irritation, menstrual problems, higher risk of miscarriage, and slower growth of newborns in the first year of life.

#3 PVC – polyvinyl chloride. Used in toys, cling wrap, clear food packaging such as cling-wrapped meats and cheeses, shampoo bottles, cooking oil, nut butter containers, shower curtains, window blinds, pipes and siding. PVC is definitely bad. It leaches phthalates (DEHP or BBzP) which are used as softeners. Phthalates mimic estrogen in the human body and are endocrine system disruptors. They have been linked to asthma, allergies, certain types of cancer, and have negative effects on the liver, kidney, spleen, bone, and body weight. The manufacturing of PVC is also quite toxic to the environment.

#6 PS – polystyrene. Used in Styrofoam, egg cartons, disposable cups, bowls, take out restaurant containers, plastic cutlery, CD cases. Leaches styrene which mimics estrogen and can disrupt the endocrine system. Can cause reproductive and developmental problems, brain and nervous system effects, and adverse effects on red blood cells, liver, kidneys, and stomach. This is also present in secondhand smoke, off gassing building materials, car exhaust and even drinking water. Benzene, a known human carcinogen, is used in the production of most styrene. This type of plastic is difficult to recycle and so mostly finds its way into the earth’s dumps and oceans.

#7 other. Other types of plastic are lumped together in this less specific category. Some like polycarbonate may be harmful, while others may be safer including newer biodegradable, plant-derived plastics made from corn/potato starch or sugar cane. Avoid polycarbonate, which is found in some plastic baby bottles, sippy cups, sports water bottles, large water storage containers, metal food can liners, and some juice and condiment containers. It leaches BPA, a harmful endocrine disrupter.
Two other plastics under #7 include acrylonitrile styrene AS, and styrene acrylonitrile SAN, which are higher quality plastics with increased strength, rigidity, and temperature and chemical resistance. Another type of #7 plastic is copolyester, which is under the trade name Tritan and the ingredients used to manufacture have not been publicized.

If you have to use plastic, which plastic numbers are considered safer?

But to undermine the whole system just noted above, at least one study found that almost all plastics #1-7 exposed to common-use stresses release chemicals with estrogenic activity anyway.

Avoiding plastic is nearly impossible if you live in civilization. Hopefully the dose makes the poison, and so doing what you can to reduce plastic in your life seems prudent for your health, and the sad state of our plasticized planet. And when science fails to inspire, read the poetry of Radiohead’s Fake Plastic Trees.

There are three forecasts I check with some regularity. Of course the weather forecast is the most important and needs no introduction… and still represents a miracle of modern technology and science. Another forecast I enjoy is the night sky constellations and astronomical objects on display in the sky above. But recently I’ve begun checking […]

According to an industry-funded, observational study in the New England Journal of Medicine, consuming either tree nuts or peanuts regularly is associated with at least a 10% lower risk of dying. A second look was taken at the Nurses’ Health Study and the Health Professionals Follow-up Study, and over 100,000 patients’ food frequency questionnaires were […]

With colder weather and fewer hours of light I have been increasingly lighting candles in my home. I enjoy the meditative, calming moment that a flickering flame instantly conjures. Humans have an innate affinity for fire light. Perhaps that attraction has been wired into our DNA, providing a survival benefit for those ancestors who did […]

Perhaps you’ve used exfoliating soaps before, and felt their gentle grit scrubbing away your dead epithelial cells. But did you know that unless you are conscientiously reading the ingredients and selecting natural soaps and face scrubs, you are likely scouring your face with hundreds of tiny plastic beads that do damage to the environment, accumulate […]

Recently a patient asked me for some very basic advice about food shopping. A recent widower with no experience cooking for himself, his diet centered around eating one meal a day at a local diner, with cereal or canned spaghetti representing a special effort at home. Listen Doc, I’m not looking for a cooking class, […]